I am not sure what this redness is due to but as it does not hurt and there is no pain, I am not too concerned. If it starts to hurt or she seems unwell generally, you best have your local doctor look at it.
By far the majority of foot problems at this age are due to ill- fitting footwear. I wonder if her foot is sliding back and forth within the shoe giving the reddish appearance but that is only a guess.
David
>
> I have twin daughters and recently in the last week I've noticed one
> of the girls (23 months old) has been presenting with a reddish,
> irregular shaped, bruiselike, non-raised lesion on the bottom of the
> inside of her heel/back of arch....is it possible she is stepping on
> toys wrong lately?I've also notice she likes to stomp her feet on
> the floor, but never seems like it is painful. I can rub the area
> without any discomfort to her, but I've noticed she's been studying
> this area of her feet as well. The other twin has nothing on the
> bottom of her feet. Their feet measure the same size and are both
> wearing the same design of sketcher size 6 1/2 shoes when we go out
> for 2-3 hours a day. Otherwise the girls run around with just socks
> or no socks inside the house.
>
> I am alittle unnerved by the red bruise, but was wondering if this
> is
> normal?
>
> concerned mom,
>
Friday, 19 December 2008
Monday, 15 December 2008
28-month-old falling a lot and walking into objects
Dear sir.
I read your answer to a grandmother who had a grand son or grand daughter at the age of 34 months that was falling a lot. I have been trying to find something about this issue online and that's how I ended up on your web page.
I am a guardian of a toddler who is 29 months and he has the same problem. He falls and stumbles over the smallest things and a lot of times he will walk into things like a table or the doorway etc. We have baby gates in the house to protect him from falling in any stairs and the house is really kid safe. He walks normal, seems to have a normal hearing and he is talking well for his age.
He has a sister that is 4 years old and she is very athletic and she never had any problems falling or walking into things like he does. The two kids spend one week with their mom and one week with their dad and are also in preschool five days a week when they are with dad. The toddlers preschool teacher asked me if we had noticed that he is always bonking into things and falls a lot. He also comes home from his mom with bruises so we know this happens here, at his mom's and in preschool.
He is also showing early "warning signs" of learning disability. He is left handed, his fine motor skills are not quite there , and he can't put a 4 piece puzzle together even if the picture of the shape is on the puzzle board. We know that he cant be diagnosed until he hits second grade, but we have been made aware of early warning signs. His dad has learning disability so we don't think it is unlikely that one or both of his kids could end up with some sort of a learning disability as well. The toddlers dad and I are doing things to try to prevent this from ever happening and we are doing it in form of fun play. The toddler loves to try to thread beads on a string, he has a box with different shaped blocks that has to go in one certain hole, we have easy wooden puzzles and building blocks to boost his imagination. And he plays the games only as long as he has fun doing it. I don't know if this can be a part of him always falling or walking into things as far as his motor skills goes.
we would be very happy if you have any ideas of what we could or should do if anything to help the "little guy" from hurting himself so much.
If you could please send me a mail back we would be very thankful.
On reading of your grandson's problems, the first thing I thought of was "Has his vision been checked?" This was because he is walking into things but as you noted he may have a muscle problem predominantly affecting his legs.
An optometrist or an ophthalmologist can check his vision while his muscles can be assessed by a physiotherapist who can also show you exercises to help any problem detected. If necessary your local doctor can refer your grandson to the above specialists - ones with expertise in assessing children would be best.
Please let me know how things turn out.
David
I read your answer to a grandmother who had a grand son or grand daughter at the age of 34 months that was falling a lot. I have been trying to find something about this issue online and that's how I ended up on your web page.
I am a guardian of a toddler who is 29 months and he has the same problem. He falls and stumbles over the smallest things and a lot of times he will walk into things like a table or the doorway etc. We have baby gates in the house to protect him from falling in any stairs and the house is really kid safe. He walks normal, seems to have a normal hearing and he is talking well for his age.
He has a sister that is 4 years old and she is very athletic and she never had any problems falling or walking into things like he does. The two kids spend one week with their mom and one week with their dad and are also in preschool five days a week when they are with dad. The toddlers preschool teacher asked me if we had noticed that he is always bonking into things and falls a lot. He also comes home from his mom with bruises so we know this happens here, at his mom's and in preschool.
He is also showing early "warning signs" of learning disability. He is left handed, his fine motor skills are not quite there , and he can't put a 4 piece puzzle together even if the picture of the shape is on the puzzle board. We know that he cant be diagnosed until he hits second grade, but we have been made aware of early warning signs. His dad has learning disability so we don't think it is unlikely that one or both of his kids could end up with some sort of a learning disability as well. The toddlers dad and I are doing things to try to prevent this from ever happening and we are doing it in form of fun play. The toddler loves to try to thread beads on a string, he has a box with different shaped blocks that has to go in one certain hole, we have easy wooden puzzles and building blocks to boost his imagination. And he plays the games only as long as he has fun doing it. I don't know if this can be a part of him always falling or walking into things as far as his motor skills goes.
we would be very happy if you have any ideas of what we could or should do if anything to help the "little guy" from hurting himself so much.
If you could please send me a mail back we would be very thankful.
On reading of your grandson's problems, the first thing I thought of was "Has his vision been checked?" This was because he is walking into things but as you noted he may have a muscle problem predominantly affecting his legs.
An optometrist or an ophthalmologist can check his vision while his muscles can be assessed by a physiotherapist who can also show you exercises to help any problem detected. If necessary your local doctor can refer your grandson to the above specialists - ones with expertise in assessing children would be best.
Please let me know how things turn out.
David
Monday, 8 December 2008
baby with Sore on chin and chest problems
I would have been very alarmed if I had seen the baby when he/she had the chest problem. I would have feared that the probable Staph. infection on the chin had spread to the lungs and Staph. pneumonia is a life-threatening condition. However, the fact that the baby has recovered is against such a diagnosis.
Probably the sore on the chin is unrelated to the chest problem. Probably the chest symptoms were due to a viral infection known as bronchiolitis. This sounds as though it was a mild episode and that the body defences have overcome the virus - most commonly one known as respiratory syncitial virus which nearly all of us catch for the first time between 0 and 2 years-of-age.
No action need be taken about the chest now that he/she is recovering and I presume the local doctor has given something for the sores on the chin.
Probably the sore on the chin is unrelated to the chest problem. Probably the chest symptoms were due to a viral infection known as bronchiolitis. This sounds as though it was a mild episode and that the body defences have overcome the virus - most commonly one known as respiratory syncitial virus which nearly all of us catch for the first time between 0 and 2 years-of-age.
No action need be taken about the chest now that he/she is recovering and I presume the local doctor has given something for the sores on the chin.
Tuesday, 18 November 2008
infant mouth ulcers
I am so sorry your daughter has this painful mouth ulceration. If your doctor thinks it is cold sores. Then she has caught it from someone else - possibly an adult or older child with a cold sore on their lips. All of us caches this infection in the first few years of our lives. The first attack usually shows as mouth ulceration - mainly inside the mouth but often on the outside too where it looks like a cold sore on an older person. Once we have had this infection 60% of us have no further problem but the other 40% are unfortunate and have cold sores on the lips whenever stressed either physically or emotionally. The commonest stress that does this is the common cold hence the name cold sores.
It is very important to keep pushing the fluids although they are painful. A small proportion of children who have this initial infection become dehydrated and need hospitalisation.
The fact that the ulcers are near her uvula suggests that they may be due to a less common viral mouth infection, called Coxsackie. The result is much the same with reduced food and fluid intake because of a sore mouth. After this form of mouth ulceration heals we don't suffer the repeated sores as do 40% of the cold sore sufferers.
You are in for a few miserable days whichever virus is responsible. Keep up the fluids.
>
> Hello,
> I just brought my 8 month old daughter to her pedia for her 2nd half
> of her flu shot while the doctor wasdoing some exams we found out
> that the inside of her mouth has cold sores,right next to her
> uvula.I was so afraid and did not realize that causes her so much
> pain when she's eating or drinking her milk from her bottle. I was
> so
> anxious that's why i wanted to ask you if this kind of viral
> infection cangive herproblem in the future or will it happen
> again?What causes this break out?
> And why would appear it by her uvula which is very unusual?Her
> doctor
> gave her a prescription to ease down the pain which is good for 7
> days.I just cant help seeing her like this.
> Please i need your response,my email is mrlflorencio@gmail.com
> again,Thank you very much for reading my letter.
It is very important to keep pushing the fluids although they are painful. A small proportion of children who have this initial infection become dehydrated and need hospitalisation.
The fact that the ulcers are near her uvula suggests that they may be due to a less common viral mouth infection, called Coxsackie. The result is much the same with reduced food and fluid intake because of a sore mouth. After this form of mouth ulceration heals we don't suffer the repeated sores as do 40% of the cold sore sufferers.
You are in for a few miserable days whichever virus is responsible. Keep up the fluids.
>
> Hello,
> I just brought my 8 month old daughter to her pedia for her 2nd half
> of her flu shot while the doctor wasdoing some exams we found out
> that the inside of her mouth has cold sores,right next to her
> uvula.I was so afraid and did not realize that causes her so much
> pain when she's eating or drinking her milk from her bottle. I was
> so
> anxious that's why i wanted to ask you if this kind of viral
> infection cangive herproblem in the future or will it happen
> again?What causes this break out?
> And why would appear it by her uvula which is very unusual?Her
> doctor
> gave her a prescription to ease down the pain which is good for 7
> days.I just cant help seeing her like this.
> Please i need your response,my email is mrlflorencio@gmail.com
> again,Thank you very much for reading my letter.
Thursday, 13 November 2008
cows milk intolerance
Dear Peter.
It sounds as though your granddaughter is having a very rough time.
The fact that she responded to the Dairy-free diet but did not have lactose-intolerance, suggests that she has cow's milk protein intolerance.
Despite your strictness with the diet, the recurrence might be due to inadvertent exposure to cow's milk. It is amazing the solids that have milk protein in them. You need to check whether any product states that it has cow's milk solids or casein in it and avoid these. The only margarine that is safe is Nuttelex.
If all this has been done, and the problem, continues, she may have developed an allergy to some other food. Just about anything can provoke an allergy, but the most likely at her ages would be eggs.
Please let me know what happens and we can pursue some other approaches.
David
>
> I hope you can help us,our 1 year old granddaughter had diahorrea
> and
> vomiting which resulted in a stay in hospital the stool was like
> clear mucus with what appeared to be seeds in it.She had a barrage
> of
> tests these showed nothing conclusive.A dietician was consulted and
> she was put on a dairy free diet.The Vomiting and diahorrea had
> stopped and her appetite seemed to have recovered however she has
> gained no weight.
> The original problem started at the begining of september but 4
> days ago the diahorrea started again and seems to be getting worse
> our daughter has been very careful to ensure she has had no dairy
> products in either her or the baby's diet and as you can imagine is
> at her wits end.Can you give us any advice?
> Yours sincerely Peter Morgan.
> P.S.The tests eliminated Lactose intolerance and Celiac disease.
It sounds as though your granddaughter is having a very rough time.
The fact that she responded to the Dairy-free diet but did not have lactose-intolerance, suggests that she has cow's milk protein intolerance.
Despite your strictness with the diet, the recurrence might be due to inadvertent exposure to cow's milk. It is amazing the solids that have milk protein in them. You need to check whether any product states that it has cow's milk solids or casein in it and avoid these. The only margarine that is safe is Nuttelex.
If all this has been done, and the problem, continues, she may have developed an allergy to some other food. Just about anything can provoke an allergy, but the most likely at her ages would be eggs.
Please let me know what happens and we can pursue some other approaches.
David
>
> I hope you can help us,our 1 year old granddaughter had diahorrea
> and
> vomiting which resulted in a stay in hospital the stool was like
> clear mucus with what appeared to be seeds in it.She had a barrage
> of
> tests these showed nothing conclusive.A dietician was consulted and
> she was put on a dairy free diet.The Vomiting and diahorrea had
> stopped and her appetite seemed to have recovered however she has
> gained no weight.
> The original problem started at the begining of september but 4
> days ago the diahorrea started again and seems to be getting worse
> our daughter has been very careful to ensure she has had no dairy
> products in either her or the baby's diet and as you can imagine is
> at her wits end.Can you give us any advice?
> Yours sincerely Peter Morgan.
> P.S.The tests eliminated Lactose intolerance and Celiac disease.
Saturday, 8 November 2008
constipated 2-year-old
> Hello,
> I have a 2 year old daughter who suffers very badly from
> constipation
> and has done since she was eight months old.I am at my wits end we
> have been to gp and tried several medication with no luck. She is
> currently on lactulose and senna. It seems to work then just doesn't
> work for while. I was advised to increase dose from 2 5ml of
> lactulose twice day to up to ten a day. This just seems such a lot
> to
> give her but did it sometimes works and other times doesnt. She has
> also had suppository aswell which didn't work well. When she tries to
> go she is in so much pain screaming which can last hours and has
> even
> hurt her back trying to do it. She can go several days trying with
> no
> luck. I dont know what to do have tried obvious diet changes etc
> with
> no luck. What would you suggest? Could she have any other medical
> problems that cause this? Could being on these medications cause
> problems later in life?
>
> please get back to me my email is danagray19@hotmail.com i would
> really appreciate it.
>
> Many thanks
>
>
I am sorry your daughter is having so much pain on using her bowels. From your description, she has a fissure-in-ano.
This is a small crack in the anus where the bowel meets the skin. When she uses her bowels the crack is torn open and causes pain. This tends to stop her using her bowels making her more constipated.
She needs a local anaesthetic ointment applied to her anus as a thin smear at night after her bath and again in the morning on waking. You can buy the ointment over the counter at the pharmacy. You can also apply the ointment during the time she is using her bowels if it is hurting.
Lactulose and senna are fine. I recommend giving the senna at night. If she fails to use her bowels in the next 24 hours then double the dose. If this does not produce a result in the next 24 hours give her half glycerin suppository and continue with the higher dose of senna. Failure to use her bowels means redoubling the dose of senna and if this does not work another half suppository. After a week of success of using her bowels the dose of senna can be halved. So 1 day of failure means doubling the dose, a week of success means halving. She may get up to quite a high dose of senna but it will do no harm. Throughout all this you continue with the twice daily local anaesthetic ointment.
These instructions are quite complex, so don't have any hesitation in asking me a question. I will be happy to hear from you.
David
> I have a 2 year old daughter who suffers very badly from
> constipation
> and has done since she was eight months old.I am at my wits end we
> have been to gp and tried several medication with no luck. She is
> currently on lactulose and senna. It seems to work then just doesn't
> work for while. I was advised to increase dose from 2 5ml of
> lactulose twice day to up to ten a day. This just seems such a lot
> to
> give her but did it sometimes works and other times doesnt. She has
> also had suppository aswell which didn't work well. When she tries to
> go she is in so much pain screaming which can last hours and has
> even
> hurt her back trying to do it. She can go several days trying with
> no
> luck. I dont know what to do have tried obvious diet changes etc
> with
> no luck. What would you suggest? Could she have any other medical
> problems that cause this? Could being on these medications cause
> problems later in life?
>
> please get back to me my email is danagray19@hotmail.com i would
> really appreciate it.
>
> Many thanks
>
>
I am sorry your daughter is having so much pain on using her bowels. From your description, she has a fissure-in-ano.
This is a small crack in the anus where the bowel meets the skin. When she uses her bowels the crack is torn open and causes pain. This tends to stop her using her bowels making her more constipated.
She needs a local anaesthetic ointment applied to her anus as a thin smear at night after her bath and again in the morning on waking. You can buy the ointment over the counter at the pharmacy. You can also apply the ointment during the time she is using her bowels if it is hurting.
Lactulose and senna are fine. I recommend giving the senna at night. If she fails to use her bowels in the next 24 hours then double the dose. If this does not produce a result in the next 24 hours give her half glycerin suppository and continue with the higher dose of senna. Failure to use her bowels means redoubling the dose of senna and if this does not work another half suppository. After a week of success of using her bowels the dose of senna can be halved. So 1 day of failure means doubling the dose, a week of success means halving. She may get up to quite a high dose of senna but it will do no harm. Throughout all this you continue with the twice daily local anaesthetic ointment.
These instructions are quite complex, so don't have any hesitation in asking me a question. I will be happy to hear from you.
David
Thursday, 18 September 2008
Frequent falls
> Dear David:
>
>
> It has been over a month now and my granddaughter is falling way
> less due to the fact that she is
> wearing those good shoes. I believe her ankles were not strong
> enough, etc. What is your
> professional opinion of this small turn of events?
>
> Thanking you in advance.
>
>
>I am delighted that she is falling less. Good shoes certainly do help weak ankles.
Did you ever get her assessed by a physiotherapist or a home visitor as I suggested?
David
>
>
>
> It has been over a month now and my granddaughter is falling way
> less due to the fact that she is
> wearing those good shoes. I believe her ankles were not strong
> enough, etc. What is your
> professional opinion of this small turn of events?
>
> Thanking you in advance.
>
>
>I am delighted that she is falling less. Good shoes certainly do help weak ankles.
Did you ever get her assessed by a physiotherapist or a home visitor as I suggested?
David
>
Saturday, 13 September 2008
Childhood Warts
Warts
Our son has a number of warts on his hands and knees. They look very ugly and he wants to get rid of them. I have heard of many different cures from friends but my doctor says there is no cure. Is there anything that can be done?
Common warts as you have described are a viral infection of the skin. Your doctor is correct to say there is no cure. They can be cut out or burnt off but will come back. This approach is reserved for those warts in an inconvenient place, for instance a wart on a finger that is interfering with writing.
As with other viral infections such as a cold, one has to wait until the body’s defence system destroys the virus. In the cas of the cold this takes a few days but with warts it takes months or years. So after having the warts for a long time, our body kills the virus and the warts disappear overnight.
The sudden disappearance of a long-standing condition, id the reason there are so many miracle cures such as burying a dead cat by moonlight – taking glucose rather than sucrose was the one I chose as a child and after many months it worked, the warts suddenly disappeared. Unfortunately my mother was still putting sucrose in her cooking. Recent medical studies have suggested that hastens the departure of warts is to cover them with duct tape. If this is true, you need to go to the hardware store – not your doctor.
Our son has a number of warts on his hands and knees. They look very ugly and he wants to get rid of them. I have heard of many different cures from friends but my doctor says there is no cure. Is there anything that can be done?
Common warts as you have described are a viral infection of the skin. Your doctor is correct to say there is no cure. They can be cut out or burnt off but will come back. This approach is reserved for those warts in an inconvenient place, for instance a wart on a finger that is interfering with writing.
As with other viral infections such as a cold, one has to wait until the body’s defence system destroys the virus. In the cas of the cold this takes a few days but with warts it takes months or years. So after having the warts for a long time, our body kills the virus and the warts disappear overnight.
The sudden disappearance of a long-standing condition, id the reason there are so many miracle cures such as burying a dead cat by moonlight – taking glucose rather than sucrose was the one I chose as a child and after many months it worked, the warts suddenly disappeared. Unfortunately my mother was still putting sucrose in her cooking. Recent medical studies have suggested that hastens the departure of warts is to cover them with duct tape. If this is true, you need to go to the hardware store – not your doctor.
Tuesday, 9 September 2008
My son, who is 18, caught acute mono over 5 months ago. He had a severe case and was unable to attend the last 3 months of school, and was one of the worst cases his doctor has seen. The severe part of his mono has gone away, but since then he still struggles daily. He has little or no appetite, strength, and seems to be constantly not feeling well. We've taken him in to get bloodwork and the results have come back 'normal'. My question is: Is this common? If not, what should we do?
The older the patient, the more severely they are affected by Infectious Mononucleosis.
A period of post-mono with the symptoms you describe is common. This may last as long as 6 months although 3 is more usual. This is despite the blood work becoming normal.
There is little you can do.You might try tempting him with his favourite foods.
David
The older the patient, the more severely they are affected by Infectious Mononucleosis.
A period of post-mono with the symptoms you describe is common. This may last as long as 6 months although 3 is more usual. This is despite the blood work becoming normal.
There is little you can do.You might try tempting him with his favourite foods.
David
high fever danger
What is a dangerous temp for an eight-month-old?
We usually become anxious when the temperature reaches 41 degrees centigrade or 105.8 and really worried at 42 or 107.6 in children. The younger the child the higher the fever they run. The figures cited above would be lower for an adult.
We usually become anxious when the temperature reaches 41 degrees centigrade or 105.8 and really worried at 42 or 107.6 in children. The younger the child the higher the fever they run. The figures cited above would be lower for an adult.
Tuesday, 2 September 2008
newborn jaundice
Our 3-day-old baby boy has developed jaundice. The doctor told us it was "physiological jaundice" and not to worry. I have heard that jaundice can be dangerous to babies. Can you he;p me?
You are right that severe jaundice can damage a baby's brain in the first week or so of life. About 40% of babies develop mild jaundice in the first few days of life. If the level is low, no risk occurs. Your doctor will (or has) measure the level to be sure that there is no danger.
The reason "physiological jaundice" happens is that the fetus in the womb needs more hemoglobin (the red pigment in blood)to carry enough oxygen than it does after being born. The bay's body breaks down the unnecessary hemoglobin which makes a yellow pigment known as bilirubin. Bilirubin is the cause of the jaundice and will go away after a few days in "physiological jaundice". If the breakdown of hemoglobin is excessive (due to a number of rare diseases that can affect babies) then severe jaundice occurs which can damage the immature newborn's brain. There are a number of treatments used if this seems likely to happen. Older children and adults may also become jaundiced but their mature brains are not damaged by it.
You are right that severe jaundice can damage a baby's brain in the first week or so of life. About 40% of babies develop mild jaundice in the first few days of life. If the level is low, no risk occurs. Your doctor will (or has) measure the level to be sure that there is no danger.
The reason "physiological jaundice" happens is that the fetus in the womb needs more hemoglobin (the red pigment in blood)to carry enough oxygen than it does after being born. The bay's body breaks down the unnecessary hemoglobin which makes a yellow pigment known as bilirubin. Bilirubin is the cause of the jaundice and will go away after a few days in "physiological jaundice". If the breakdown of hemoglobin is excessive (due to a number of rare diseases that can affect babies) then severe jaundice occurs which can damage the immature newborn's brain. There are a number of treatments used if this seems likely to happen. Older children and adults may also become jaundiced but their mature brains are not damaged by it.
Saturday, 16 August 2008
Exercise cramps
My son is almost13 very active. He has a problem with leg cramps. A friend who is pharmacist said to give him potassium supplement and have him chew a couple of Rolaids before game. We have eliminated soda on game day and drink water all day. He will then drink power aide during game and more water after game. He still having problems. He is never sick. He is great eater loves veggies and fruit can’t figure it out can you help?
Firstly your son is perfectly healthy. Cramping during or after sport is very common. I am afraid that I don’t know what Rolaids are and therefore what they contain.
If the potassium supplement does not help, I would try a quarter teaspoon of salt and a glass of water about half an hour before the game (DO NOT GIVE MORE SALT THAN THAT). I APPROVE OF Poweraide during the game – it contains both sodium and potassium.
If he still gets cramps after the game the quarter teaspoon of salt plus water can be tried again. The liberal water before and after the game is fine.
Please tell me what is in Rolaids, how he goes and (out of interest) what sport he plays. Tell him I am sympathetic as I was a sufferer with cramps after exercise.
Firstly your son is perfectly healthy. Cramping during or after sport is very common. I am afraid that I don’t know what Rolaids are and therefore what they contain.
If the potassium supplement does not help, I would try a quarter teaspoon of salt and a glass of water about half an hour before the game (DO NOT GIVE MORE SALT THAN THAT). I APPROVE OF Poweraide during the game – it contains both sodium and potassium.
If he still gets cramps after the game the quarter teaspoon of salt plus water can be tried again. The liberal water before and after the game is fine.
Please tell me what is in Rolaids, how he goes and (out of interest) what sport he plays. Tell him I am sympathetic as I was a sufferer with cramps after exercise.
Saturday, 9 August 2008
Urinary frequency in a 3 year boy
My 3 and half year-old son urinates frequently. He will just have gone to the toilet only to wee a few minutes later. He sometimes remembers to go most times but often not and will wet his pants. We have had him tested for diabetes insipidus but the results came back normal. He also under went an MRI of the brain. His fluid intake is normal. Any ideas of what the next step could be.
Your son has certainly had very sophisticated investigations for his urinary frequency. I presume he has had a test for urinary tract infection and diabetes mellitus. I would very much like you to inspect the tip of his penis. If he is uncircumcised push the foreskin back gently (DO NOT FORCE IT BACK) and see if there is any infected material under the foreskin. If he is circumcised look for a small ulcer adjacent to (and possibly running into) the hole at the tip. If either of these is present you need to see your doctor again.
Is he fearful of going to the toilet. All these ideas are to see if he is only letting out a small quantity of urine at each visit.
I would be interested in what happens.
Your son has certainly had very sophisticated investigations for his urinary frequency. I presume he has had a test for urinary tract infection and diabetes mellitus. I would very much like you to inspect the tip of his penis. If he is uncircumcised push the foreskin back gently (DO NOT FORCE IT BACK) and see if there is any infected material under the foreskin. If he is circumcised look for a small ulcer adjacent to (and possibly running into) the hole at the tip. If either of these is present you need to see your doctor again.
Is he fearful of going to the toilet. All these ideas are to see if he is only letting out a small quantity of urine at each visit.
I would be interested in what happens.
Saturday, 26 July 2008
vomiting and sezures
I have a 4 year old daughter with a history of seizures (seizure
free for over a year) and a history of reflux (not a problem for over 2
years.) In April she had an episode of repeated vomiting.
Then, it happened again in June. Then, July 10th it started. We have
not had more than 24 hours vomit free since July 10th. She has also
had diarrhoea part of that time. She has an immuno compromised sister
who has been totally healthy through this. That virtually eliminates
the possibility that it is contagious.
My children are already gluten free. However, even the gluten free
foods are making my child sick now. The only things she can keep
down are rice crackers and chicken with rice soup. She wakes up vomiting
in the middle of the night and we are worried she is going to choke.
We have done blood work to check for food allergies and are waiting
on those results. We are going to do an x-ray just to make sure
there isn't something there. We are going to try Pepcid to ensure it's not
reflux related. Since this started she has also started seizing
again. They aren't sure which condition is causing the other, so
they are talking about a brain MRI as well.
Do you have any other suggestions of things that we can check for?
We will be doing more blood work in a few days so I want to include
anything we can so we don't have to do it again. She is a petite
child to begin with and she's already lost some weight. In our
family we often deal with "rare" things. So, even if it is rare I still
want to hear about it.
Thank you.
Chelsea
Dear Chelsea,
How very distressing this must be for you.
The combination of seizures plus vomiting would make me very keen indeed to have an MRI of her head.
Blood tests for food allergies are helpful but not conclusive and you may find that your doctor wants to withdraw a food for 3 weeks and the challenge her with it again after the 3 weeks has been completed.
Thursday, 24 July 2008
Toddler Falling a lot
My 34 month old granddaughter falls a lot. Loses her balance a lot. She is very bright with no speech or hearing problems, although she failed her birth audio. but when she went back for a 2nd test,passed. My daughter took her to an ent specialist a few months ago and she failed her test in one ear, but they were puzzled by this and wanted to put her to sleep for testing. She does have flat feet and her left one turns out very slightly. This situation is of great concern to me.
Thanking you in advance.
Nancy
Dear Nancy,
I note your concern. I doubt that ear problems are connected to the falling, even though the inner ear is responsible for balance. If she does have the hearing test while asleep, find out if the hearing loss (if any) is of a conductive type. It most likely is and that would not be connected with her falling.
Flat feet at 34 months can be considered normal. Toddlers have very lax ligaments and the arch of the foot contains a pad of fat which disappears as the toddler grows older. The turned out foot is probably OK too but with the frequent falls makes me wonder if her local doctor has assessed her legs for stregth and normality of (tendon) reflexes. If these are normal, I would be prepared to wait and see. It is normal for toddlers to fall a lot so much so that they usually have bruises on the front of their legs and often on their foreheads. Falls on flat surfaces are not a worry but your daughter should be protected from falling down stairs by a gate at the head of the stairs.
Thanking you in advance.
Nancy
Dear Nancy,
I note your concern. I doubt that ear problems are connected to the falling, even though the inner ear is responsible for balance. If she does have the hearing test while asleep, find out if the hearing loss (if any) is of a conductive type. It most likely is and that would not be connected with her falling.
Flat feet at 34 months can be considered normal. Toddlers have very lax ligaments and the arch of the foot contains a pad of fat which disappears as the toddler grows older. The turned out foot is probably OK too but with the frequent falls makes me wonder if her local doctor has assessed her legs for stregth and normality of (tendon) reflexes. If these are normal, I would be prepared to wait and see. It is normal for toddlers to fall a lot so much so that they usually have bruises on the front of their legs and often on their foreheads. Falls on flat surfaces are not a worry but your daughter should be protected from falling down stairs by a gate at the head of the stairs.
Wednesday, 2 July 2008
Physical child abuse and neglect
I have been seeing so much about child abuse and neglect in the media lately. Why do you think this is happening so much these days? What can be done about it?
I will restrict my answer to physical abuse and neglect. This is not because sexual abuse is not important but because it is, in my opinion, a different problem for which we do not have a satisfactory answer other than gaoling the perpetrators.
At least 80% of parents who abuse their children were themselves abused as children. These parents have a very poor model of parenting and very poor self esteem. While they hated being abused and swore they would not do it when they grew up, under stress they revert to the model they experienced as children. They are, in fact, sad parents.
Of the remainder psychiatric disease, if one includes depression and alcohol and drug abuse under that heading, is the main reason. Very few abusers are simply evil people but unfortunately those that are capture most of the media attention.
At this point I should point out that if you were abused as a child it does not mean that you will become an abusive parent. 75% of abused children do not abuse as parents – a triumph of the human spirit! Also child abuse was not non-existent in the old days. It simply went unrecognised as a problem. It was not taught to me or any medical student in the nineteen fifties. There was a famous case of an abused girl who was brought to the attention of the courts at the end of the nineteenth century. The case was thrown out because a parent was totally responsible for their child. The case was brought again but under the Prevention of Cruelty to Animals act and was successful!
What can be done about it? The simply evil (bad) parents have to have their children removed and face the law. The psychiatric (mad) parents need psychiatric treatment and in many cases the children may need alternative care at least on a temporary basis.
However, the vast majority (80%) need support in their parenting and many organisations attempt to do this. In the old days family and neighbours did this but this often not available in modern society. Unfortunately, the main need is for emotional support – not budgeting, housekeeping etc (although this may also be needed)-and this takes time: more time than society can afford to pay if one uses an employed social worker, visiting nurse or any paid supporter. The most successful program was introduced by the late Henry Kempe in which he used trained volunteer mothers whose task was to “mother the mothers”. This program has been emulated in many other places around the world. I ran one such program with the high success that Kempe found but it took 20 hours per parent per month. Society simply could not afford to pay a salary for such parent-helpers given the rates of child abuse that we currently have.
In the last 50 years we have recognised the problem of physical abuse and neglect. We have learnt a lot about its causes and I think we have found a successful treatment for many cases. It is a dismal picture at the moment but I believe there is cause for hope.Tuesday, 17 June 2008
persistent diarrhoea and abdo pain
Thank you for writing back so quickly, my daughter has had a stool sample taken last week that came back clear. She also has been on a dairy free diet since January. The doctor said to put her on a wheat free diet to see if we can get an improvement but she is still in a lot of pain at the moment. I will let you know the outcome once she has been on it for a couple of weeks. Thank you for your time and advice.
Kerry
A routine stool sample will not detect Yersinia and may not detect Giardia. Your doctor has to specifically ask the laboratory to look for Yersinia. Giardia is so often missed that I would treat her for Giardia anyhow.
I am sorry you are having so much trouble. If the above does not detect the reason or cause improvement, she should have a urine collected and analysed for infection.
Please do let me know what happens.
David Robinson
Kerry
A routine stool sample will not detect Yersinia and may not detect Giardia. Your doctor has to specifically ask the laboratory to look for Yersinia. Giardia is so often missed that I would treat her for Giardia anyhow.
I am sorry you are having so much trouble. If the above does not detect the reason or cause improvement, she should have a urine collected and analysed for infection.
Please do let me know what happens.
David Robinson
Monday, 16 June 2008
persitent infantile diarrhoea
Dear Kerry,
This sounds like she has lactose intolerance probably brought on by a gastro bug. She needs to go on a milk product-free diet. This means no milk, no cream, no cheese, no icecream and no commercial products that contain milk such as bread, biscuits,most margarines and yogurts. Check commercial products to make sure they don't contain "milk products or "casein"-this means you will have to do a lot of home cooking. She should stay on the milk-free diet for 2-3 weeks to let the gut heal although you should see an improvement long before that time.
If this does not work ask your doctor to look for Yersinia and Giardia in a faeces specimen and treat her for Giardia anyhow as it is sometimes difficult to detect. Uncommonly diarrhoea can be due to a urinary tract infection but it is so difficult to collect a suitable urine sample, I would wait until all the above have been done.
If none of these work ger back to me as there are further things that could be considered. I would be interested in what happens in any case.
David Robinson.
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Saturday, 14 June 2008
severe infectious mononucleosis
Hello:My daughter is 7 and has been diagnosed with mono. She started with a low grade temp for 12 days off and on. Then she got the "bad attack". She has had high temps for the last 5 days. They get up to 104.5-105.4 if I am not giving her tylenol and/or ibuprofen every 4-6 hours. Her spleen is swollen, tonsils are very swollen, bad headache and in bed for 5 days. Yesterday she had difficulty even walking because of weakness. It is my understanding that children this age typically do not get mono this bad. Will this last longer for her because of the severity of her symptoms and how long should she have this high fever? She is also taking codeine for the pain. Thank you for any information you can offer me. Leanne.
Dear Leanne,
You are correct, the younger the sufferer of mono the milder it is in most cases. This usually means that children under 6 do not have the diagnosis made although they certainly do catch it.
I presume your doctor has confirmed the diagnosis and a blood test has been taken.
I guess there are always exceptions to the rule. I don't think she will have an unusually long course because it is so severe - this is based on my own observations and I am not aware of any proper scientific study that has measured length of illness against severity in mono.
I would not base the giving of Tylenol on the presence of fever but more on whether she is in pain or not. Fever is one of the body's defences against viral infection, which mono is. Temperatures around 105 are rare in adults but quite common in children.
Regrettably, there is little modern medicine can do to help your daughter to overcome mono but she will recover.
David Robinson
Dear Leanne,
You are correct, the younger the sufferer of mono the milder it is in most cases. This usually means that children under 6 do not have the diagnosis made although they certainly do catch it.
I presume your doctor has confirmed the diagnosis and a blood test has been taken.
I guess there are always exceptions to the rule. I don't think she will have an unusually long course because it is so severe - this is based on my own observations and I am not aware of any proper scientific study that has measured length of illness against severity in mono.
I would not base the giving of Tylenol on the presence of fever but more on whether she is in pain or not. Fever is one of the body's defences against viral infection, which mono is. Temperatures around 105 are rare in adults but quite common in children.
Regrettably, there is little modern medicine can do to help your daughter to overcome mono but she will recover.
David Robinson
Saturday, 31 May 2008
?diabetes
My 6 year old seems to be drinking more frequently and urinating more frequently as well. About every hour she seems to have to go. I don't want to jump to conclusions that it could be juvenile diabetes but I don't want to ignore any symptoms either. She has no other abnormal behaviours. What do you think this can be or is there nothing to worry about at all?
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> There are a number of causes of extra intake of fluid and increased urinary output. A common cause of urinary frequency is a urinary tract infection but this does not cause increased drinking. However, it affects some 6% of schoolage girls.Your doctor can chek for this.
You are right to consider sugar diabetes. Your local doctor can easily check for this if you can collect a urinary specimen in a very well cleaned jar or the surgery can give you a proper specimen container.
There are rarer causes of these symptoms which I am sure your doctor will consider if the urine is normal. Excessive drinking can just be a habit with no disease and, of course, the extra fluid has to be passed out as urine.
Best of luck and please do tell me what happens.
David Robinson
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Saturday, 2 February 2008
"Mono" experience
I’m 15 and I currently have Mononucleosis. I have been sick for about 2 weeks now. I first woke up with an extremely sore throat so badly I couldn’t even swallow my own spit. The sore throat continued for about a week and then my spleen enlarged and I could feel pressure on my stomach. My neck was so sore and my whole upper body ached. Now I just feel tired and weak all the time.
I hope my experience helps in a way.
You have described a typical attack of infectious mononucleosis. You have my sympathy because you have had a fairly severe attack and I am glad you are on the mend. Unfortunately the feeling weak and tired may last for some time – up to 3 months – but it gradually gets better.
I am sure that others suffering “Mono” will be grateful to hear of your experience and the fact that it does get better, Thank you for sharing with us.
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